Income Class Research Articles

몽골인의 사회계층이 관광 목적지 숙식 및 체험활동 선택에 미치는 영향 : 홉스골 국립공원 지역 관광자를 대상으로 한 이항 로지스틱 회귀분석

Looking at Mongolian tourists to the Khuvsgul National Park area, this study examines the impacts of tourists’ social stratification on their accommodation, dining, and experiential activity choices. The survey was conducted both online and offline at five different accommodations in the Khuvsgul National Park area between January 2024 and March 2024, and 288 valid questionnaires were used for the binary logistic regression analysis. The results showed that tourists’ occupation, average monthly household income, and subjective social class significantly influenced their choice of either luxury (e.g., hotels and resorts) or inexpensive accommodation (e.g., traditional Mongolian ger camps). Specifically, office workers were about 4.24 times more likely to stay in hotels or resorts than unskilled laborers, and the probability of staying at a hotel or resort increased by 1.45 times with each increment in subjective social stratification. In regard to tourists' dining choices (i.e., eating at hotel or resort restaurants vs. bringing their own food or eating at regular restaurants), average monthly household income and subjective social class had significant effects. However, education level influenced neither accommodation nor dining choices. Finally, tourists’ choices of some experiential activities (e.g., Tsaatan experience and Sukhbaatar ship travels) were influenced by their occupation and other control variables such as gender and age. The study findings and their implications were further discussed at the conclusion of this article.

Using Machine Learning to identify the social determinants of the mid-life decline in mental health

Abstract Background The mid-life decline in mental well-being, depicted as a U-shaped pattern, is debated across disciplines. This study seeks to identify the social determinants of this decline and the overall contribution of social determinants to changes in mid-life mental health. Methods We use data from the 1970 British Cohort Study, from the ages 26, 34, and 42 (N = 6992, 51.5% female). Mental distress was measured using the 9-score Malaise Inventory. Mental distress increased from age 34 (M = 1.67) to 42 (M = 1.86; p < 0.001), with 17.8% declining by at least 1 SD on the inventory. We contrasted this group of decliners with those exhibiting stable mental health. We included socioeconomic and family factors, as well as physical health and health behaviours as potential determinants of mental health decline (at ages 26, 34, or at birth). We combine Random Forest and logistic regressions. Results The Random Forest’s Variable Importance (VI; root Mean Squared Error (MSE)), revealed social class at birth (VI = 0.023), physical multimorbidity at age 26 (VI = 0.22), and income quintile at age 34 (VI = 0.022) as most important predictors. Regressions confirmed that low birth social class (OR = 1.51 [1.25-1.83]), high-income at age 34 (OR = 0.68 [0.53-0.88]), and physical multimorbidity at age 26 (OR = 1.25 [1.06-1.48]) predict mental health decline. For those with high income and social class, the predicted probability of mid-life mental health decline is 0.109 (CI = [0.08-0.139]), rising to 0.277 (CI = [0.227-0.324]) for high risk individuals. Social class does not predict changes in mental health between ages 26 - 34. Interpretation We show that various social determinants of health contribute to the observed decline in mental health during mid-life. Social class at birth, income, and physical health are the most relevant predictors; they reduce the risk of decline from up to 27% to 11%. The contribution of social class appears specific to mid-life, and it could help explain the U-shaped pattern. Key messages • Social Factors Matter: Social class, income, and health predict mid-life mental decline. • Mid-life Class Impact: Social class uniquely affects mental health decline in mid-life.

Family affairs or Government's duty? The tax morality of a mobile society

PurposeThis paper aims to shed light on the relationship between intergenerational labor mobility and tax morale among European citizens, given the relatively limited evidence on the potential influence of tax compliance behavior on future inequalities.Design/methodology/approachExploiting data from the European Values Study (2008), we show that the larger the intergenerational mobility, i.e. better economic conditions of children respect to their parents, the larger the willingness to pay taxes. In this vein, the subjective tax payment may be meant as an investment which could be rewarded with a more mobile society result by considering different estimation strategies. This evidence remarks the importance to foster intergenerational mobility to build a more tax-compliant society.FindingsThe linkage between mobility and tax morale is stronger and significant across citizens living in high income classes, and in countries where there is a commitment of the Government in guaranteeing more opportunities to citizens regardless of their familiar starting conditions (more defamiliarized countries). We further show that the intergenerational mobility significantly shapes the attitude towards tax payment only among individuals who claim for independence from their family context (i.e. those showing less family ties). This evidence remarks the importance to foster intergenerational mobility to build a more tax-compliant society.Originality/valueWe revisit the linkage between attitude toward tax compliance and inequality, on the light of the intergenerational labor mobility, that may be seen as the dependence between children's and parents' earnings. Given the insights from the existing studies, this paper represents the first empirical work that aims to analyze the potential relationship between intergenerational mobility and personal attitude toward tax payment across European citizens.

The impact of work-family conflict on Chinese women’s fertility intention: the role of fertility attitude, income class, and child-rearing burden

The struggle women face in balancing work and family roles is a significant factor contributing to the decline in their fertility intentions. Therefore, work-family conflict serves as a crucial determinant influencing women’s fertility intentions. This study aims to explore the internal mechanism between work-family conflict and the fertility intentions of Chinese women, using data obtained from 334 questionnaires. Data analysis was conducted using Mplus 8.0. The following conclusions were drawn: (1) There is a negative correlation between work-family conflict and women’s fertility intentions. (2) Fertility attitudes play a mediating role in the relationship between work-family conflict and women’s fertility intentions. (3) The relationship between work-family conflict and women’s fertility intentions is moderated by income class. (4) The relationship between work-family conflict and women’s fertility intentions is moderated by women’s child-rearing burden. The findings of this study provide a foundation for governments at all levels to formulate population policies.

Falling sideways? Social status and the true nature of elite downward mobility

Downward mobility is an essential, but commonly overlooked component of social mobility. Existing estimates of downward mobility are routinely based on unidimensional measures of income and social class. This ignores the potential for substantial retention of advantage in other domains of stratification – particularly social status.In this paper, I use highly detailed occupational data from a representative UK sample to examine patterns of multidimensional mobility among those from the most advantaged backgrounds. I find that multidimensional measures reveal dramatically different patterns of downward mobility – particularly for women, who, when downwardly mobile in terms of social class, often retain privileged social status positions.I also find that those whose parents held jobs at the very top of the status distribution were much less likely to be downwardly mobile than previous mobility estimates have suggested – consistent with public perceptions of a ‘glass floor’.

On the decomposition of the extensions of the Gini index that are based on the ‘metallic’ sequences of number theory

AbstractThe present paper extends the work of Subramanian (Econ Bull 41(4):2309–2319, 2021), as well as that of Creedy and Subramanian (Exploring a new class of inequality measures and associated value judgements: Gini and Fibonacci-type sequences, 2022), by showing how this new extension of the Gini index may be decomposed by income sources, income classes and population subgroups. It also gives an empirical illustration applying this extension of the Gini index to the analysis of the inequality in expenditure on social protection among European countries in 2018. In the decomposition by benefit function it appears that the housing function consistently exhibits the smallest contribution, due to its low expenditure weight, while the old-age function has the lowest inequality but the highest contribution, due to its substantial expenditure weight. The family/children function's contribution increases when a higher weight is given to lower expenditures, highlighting a pronounced inequality at lower expenditure levels. Conversely, the old-age function shows higher inequality among countries with higher expenditures. In the breakdown by welfare systems, we observe greater inequality between systems than within them.

Menstrual practice needs among college going women in Coimbatore district, India: an analytical cross-sectional study

BackgroundIn India, twenty-five percent of women who menstruate are unable to utilize sanitary methods, and even among those who have access, there are multiple obstacles to achieving proper menstrual hygiene management. The consequences of inadequate menstrual health may extend to affect a girl’s socialisation, empowerment, overall well-being, and even survival. ObjectivesTo estimate the prevalence of unmet menstrual practice needs and its determinants among college going women in Coimbatore district, India. MethodologyA questionnaire based analytical cross-sectional study was conducted among 3144 college going women from October 2022 to January 2023. Menstrual Practice Needs Scale (MPNS-36) was used to collect data regarding the unmet needs and their mean scores were compared across socio-demographic variables, menstrual knowledge, and the choice of hygiene material. ResultsThe mean (SD) age of the study population was 19.3 (1.8) years. The prevalence of unmet menstrual practice needs was 62.8% with a mean (SD) MPNS score of 1.8 (0.4). The total MPNS score was low for those currently residing in rural or having a rural hometown. The unmet need was better for those residing in-campus of the educational institute and having educated parents. The socioeconomic class and presence of a personal income also influenced the total MPNS scores significantly (p < 0.05). Menstrual talks with friends before puberty and with friends and family after puberty improved the MPNS scores. Regarding menstrual hygiene methods, modern menstrual methods (MMM), disposable and bio-degradable materials had a lower unmet need. Marital status, freedom to manage expenses, pre-pubertal menstrual talks with family, and total number of family members did not influence the scores of MPNS. Multivariate regression analysis showed that maternal education, menstrual talks with family after puberty, and type of menstrual hygiene method including its disposability were independent predictors of total MPNS scores. ConclusionAddressing unmet menstrual practice needs among college-going women in Coimbatore district necessitates a multifaceted approach encompassing education, access to affordable and sustainable menstrual products, and destigmatization efforts.

Socioeconomic Status and Time to Treatment in Patients With Traumatic Rotator Cuff Tears.

Socioeconomic status (SES) affects access to care for traumatic rotator cuff (RTC) tears. Delayed time to treatment (TTT) of traumatic RTC tears results in worse functional outcomes. We investigated disparities in TTT and hypothesized that individuals from areas of low SES would have longer time to surgical repair. Patients who underwent repair of a traumatic RTC tear were retrospectively reviewed. Median household income and Social Deprivation Index were used as a proxy for SES. The primary outcome was TTT. Patients were further stratified by preoperative forward flexion and number of tendons torn. A total of 221 patients met inclusion criteria. No significant difference in TTT was observed between income classes (P = 0.222) or Social Deprivation Index quartiles (P = 0.785). Further stratification by preoperative forward flexion and number of tendons torn also yielded no significant difference in TTT. Contrary to delays in orthopaedic care documented in literature, our study yielded no difference in TTT between varying levels of SES, even when stratified by the severity of injury. Thus, we reject our original hypothesis. Based on our findings, mechanisms in place at our institution may have mitigated some of these health disparities within our community.

POTENSI UMKM BATIK PARIJOTO KUDUS SEBAGAI PENDUKUNG EKONOMI GUNA MEWUJUDKAN SDGS MENUJU MEGATREND 2045

Indonesia is a country where UMKM are experiencing significant changes and it is estimated that in the next twenty years there will be major changes. This is proven by the number of global middle income classes which is predicted to increase by 4.9 billion by 2045. One area with a number of MSMEs that have entered the product projection stage is Kudus Regency, where out of thousands of MSMEs, 15 business actors can export abroad. According to the KBBI, megatrend means a big trend in style. In other words, a megatrend is a trend that has an impact on a large scale. Megatrend can also be interpreted as a major change in social, economic, political and technological aspects that is slow to form and after this change occurs, it can have an influence over a long period of time. The aim is to be able to prioritize digital economic transformation and be a reference for further research. This paper uses a qualitative method by taking a descriptive approach. At the data collection stage, the author collects various types of information related to the topics discussed through online platforms such as journals, books and papers, as well as other supporting data so that it is optimal if used as material for consideration. Then, the results of this research are as economic support, namely the Kudus Parijoto batik MSMEs trying to be present in building a quality next generation of the nation, especially preserving the sustainable local wisdom of the Kudus community. The following are several government actors who participate in supporting the economy of the Kudus community through Parijoto batik MSMEs, including the Ministry of Cooperatives, Small and Medium Enterprises, the Ministry of Industry, and the Ministry of Industry. The hope is that it will be able to improve the quality of human resources, thus helping them be more independent with the knowledge they have acquired and participate in boosting the economy of each family. Keywords: UMKM, Networking Management, SDG's

Healthcare Utilization and Discrepancies by Income Level Among Patients With Newly Diagnosed Type 2 Diabetes in Korea: An Analysis of National Health Insurance Sample Cohort Data.

The use of qualitative healthcare services or its discrepancy between different income levels of the type 2 diabetes (T2D) patients has seldom been studied concurrently. The present study is unique that regarding T2D patients of early stages of diagnosis. Aimed to assess the utilization of qualitative healthcare services and influence of income levels on the inequality of care among newly diagnosed patients with T2D. A retrospective cohort study of 7590 patients was conducted by the National Health Insurance Service National Sample Cohort 2.0 from 2002 to 2015. Insured employee in 2013 with no history of T2D between 2002 and 2012 were included. The standard of diabetes care includes hemoglobin A1c (HbAlc; 4 times/y), eyes (once/y) and lipid abnormalities (once/y). Multivariate logistic regression analysis was performed to examine the difference between income levels and inequality of care. From years 1 to 3, rates of appropriate screening fell from 16.9% to 14.1% (HbA1c), 15.8% to 14.5% (eye), and 59.2% to 33.2% (lipid abnormalities). Relative to income class 5 (the highest-income group), HbA1 screening was significantly less common in class 2 (year 2: odds ratio [OR], 0.78; 95% confidence interval [CI], 0.61 to 0.99; year 3: OR, 0.79; 95% CI, 0.69 to 0.91). In year 1, lipid screening was less common in class 1 (OR, 0.84; 95% CI, 0.73 to 0.98) than in class 5, a trend that continued in year 2. Eye screening rates were consistently lower in class 1 than in class 5 (year 1: OR, 0.73; 95% CI, 0.60 to 0.89; year 2: OR, 0.63; 95% CI, 0.50 to 0.78; year 3: OR, 0.81; 95% CI, 0.67 to 0.99). Newly diagnosed T2D patients have shown low rate of HbA1c and screening for diabetic-related complications and experienced inequality in relation to receiving qualitative diabetes care by income levels.

Health and income inequality: a comparative analysis of USA and Italy.

Socio-economic background is often an important determinant for health with low income households having higher exposure to risk factors and diminished access to healthcare and prevention, in a way that is specific to each country. Here, we perform a comparative analysis of the relations between health and income inequality in two developed countries, USA and Italy, using longitudinal and cross-sectional data from surveys. We show that the income class determines the incidence of chronic pathologies, associated risk-factors and psychiatric conditions, but find striking differences in health inequality between the two countries. We then focus our attention on a fraction of very disadvantaged households in the USA whose income in persistently at the bottom of the distribution over a span of 20 years and which is shown to display particularly dire health conditions. Low income people in the USA also display comorbidity patterns that are not found in higher income people, while in Italy income appears to be less relevant for comorbidity. Taken together our findings illustrate how differences in lifestyle and the healthcare systems affect health inequality.

Mild traumatic brain injury caused by workplace violence in a US workers’ compensation system

ObjectivesApproximately 81% of traumatic brain injury cases are considered to be mild (mTBI), but few studies have reviewed mTBI caused by workplace violence (WPV). This study aimed to (1) determine...

The relationship between quality of life and some mental problems in women with gestational diabetes mellitus (GDM): a cross-sectional study

BackgroundWomen with medical problems during pregnancy, including women with Gestational Diabetes Mellitus (GDM), experience an increased prevalence of mental health disorders which can affect their quality of life. This study aimed to assess the relationship between GDM-related quality of life and depression, anxiety, and stress.MethodsThis analytical cross-sectional study was performed on 150 women with GDM. The participants were selected using a multi-stage sampling including quota and then randomized method from maternal care centers affiliated with Shahid Beheshti University of Medical Sciences, Tehran-Iran. The data were collected using a personal information questionnaire, the GDM-related quality of life questionnaire (GDMQoL-36), and the depression, anxiety, and stress scale (DASS). The data were analyzed using SPSS-23 software and statistical tests of coefficient Spearman’s correlation, t-test, analysis of variance, and multiple linear regression.ResultsThe mean ± SD score for the GDM-related quality of life and the DASS scale were 55.51 ± 8.87 and 27.12 ± 19.43%, respectively. Different degrees of depression, anxiety, and stress were present in 40, 61.3, and 42% of women, respectively. The total score of GDM-related quality of life had a significant negative correlation with the total score of DASS and the scores of the subscales including depression, anxiety, and stress (P < 0.001). There were significant correlations between the total score of GDM-related quality of life with age, BMI, length of marriage, educational level of the woman and her spouse, the occupation of the woman and her spouse, income, and economic class of the family. Multiple linear regression revealed that depression, education, and job are predictive factors for GDM-related quality of life.ConclusionGDM-related quality of life is related to some mental disorders. Therefore, it is important to consider the mental health promotion of pregnant women with GDM in future prenatal health programs to improve their quality of life. This also shows the importance of integrating mental health promotion strategies to enhance the quality of life of pregnant women with GDM.

Low back pain classifications and their associations with disability, quality-of-life, and sociodemographic factors: a comprehensive examination using the PainDETECT questionnaire

Background Low back pain (LBP) is a debilitating phenomenon that significantly impacts quality-of-life (QoL). The PainDETECT questionnaire (PD-Q) is a screening tool aimed at distinguishing nociceptive pain (NoP) and neuropathic pain (NeP) classifications. Associations between these classifications and patient-reported outcome measures (PROMs) and sociodemographic parameters are yet to be established. Objective The study aimed to determine the relationship between NeP as assessed by the PD-Q and pain, disability, QoL, and sociodemographic factors. Methods A retrospective analysis of an ongoing prospectively collected database was conducted involving 512 patients aged >18 years who presented to a tertiary spine clinic for LBP having completed the PainDETECT questionnaire, Oswestry Disability Index (ODI), EuroQol Five-Dimensional (EQ-5D) questionnaire, or answered questions regarding sociodemographic status. Results The NeP group had a higher mean numerical rating scale (NRS) score (7.96 ± 1.54 vs. 5.76 ± 2.27, p <.001) and lower age (55 ± 15.6 vs. 59 ± 17.8, p <.05) compared to the NoP group. When confounded for NRS, analysis of covariance demonstrated an 89.5% higher total ODI score (p <.001) and 50.5% lower EQ-5D utility score (p <.001) in the NeP compared to NoP group. Smokers and individuals with a no partner marital status were 2.373 (OR = 2.373, 95% CI = 1.319–4.266, p <.01) and 2.384 times (OR = 2.384, 95% CI = 1.390–4.092, p <.01) more likely to have NeP compared to NoP, respectively. Patients with NeP were also of lower income class compared to patients with NoP (Z = −2.45, p <.05). Conclusion NeP was associated with higher levels of disability and lower QoL. Smokers, individuals with a no partner marital status, and individuals with a lower income class were more likely to suffer NeP rather than NoP. These findings have illuminated a crucial notion: in patients with elevated NRS, the detrimental impact of NeP on patient wellbeing underscores the fundamental need to represent pain on a nociceptive-neuropathic continuum, permitting more accurate differentiation of pain components.

Functional distribution, personal income inequality, and top shares of income: do social classes still matter?

AbstractThis paper aims at providing new evidence about the link between personal and functional distribution and top-shares composition. We apply a novel class scheme based on two key features of contemporary capitalism i.e., individuals/households receiving multiple types of incomes, and the role of managers. The empirical application in Germany, Spain, and Italy over the period 2000–2017 reveals two main results. First, we observe a direct link between personal and functional distributions. A marginal increase in wages received by labourers would reduce inequality, whereas those received by capitalist households would increase it. Second, we find that a significant portion of labour income at the top of the income distribution corresponds to wages received by capitalist households. We conclude that although the linear correspondence between income source and class location is more blurred today than it was 200 years ago, a class divide is still clear and more prominent than what is often indicated in the literature.

Consumers’ purchasing behaviour and quality preferences for pork sold in the informal street markets of the Cape Metropole, South Africa

ABSTRACT The current study evaluated the factors influencing the purchasing behaviour and pork quality preferences of 211 consumers in the Cape Metropole District, South Africa. Two-thirds of the participants bought cooked pork from the informal street markets because of affordability (36%), convenience (34%), and price (41%). Most consumers preferred grilled (87%), well done (68%) and bone-in (57%) meat of moderate lean thickness (48%). Cut type (33% of consumers) and taste (52%) were the most important pork quality indicators. Prior to purchasing pork, 70% of consumers performed a safety assessment, mostly based on pork appearance (40%). Two-thirds of consumers indicated their willingness to pay more for safe pork. Marginal effects from logistic regression showed that the likelihood of consumers to assess pork safety was positively influenced (P ≤ 0.05) by gender and education level, while the source of income, income class, and education level positively influenced (P ≤ 0.05) consumers' willingness to pay more for safe pork. Findings suggest that policy and development interventions by the government and municipalities to match quality attributes of pork to the preferences of consumers in the informal urban street markets should target specific sub-groups of the population, particularly females, low-income earners and the less educated.

Do environmental awareness and food safety information nudges enhance youth’s affinity to safer food consumption? Findings from an experiment in Nepal

PurposeUnsafe food consumption results in adverse health conditions, foodborne illness and undernutrition among households and communities. The consumption of food contaminated with harmful microorganisms or with harmful pesticide residuals results in adverse health conditions and undernutrition. However, there are a number of challenges to maintaining food safety in the food systems of developing countries, like Nepal, where awareness of food safety is low and research on these issues is lacking.Design/methodology/approachWe conducted an experiment among youth aged between 20 and 26 years in Nepal to assess their food safety awareness and affinity to safer fresh produce choices. In the classroom setting experimentations with and without information nudges conducted among 224 youth participants, participants chose one fresh produce packet among the four. We analyzed results using multinomial and mixed logit models appropriate for discrete choice modeling.FindingsWe found that the youth’s perceived higher importance of sustainable food systems and their knowledge levels on microbial contamination and foodborne illnesses play significantly positive roles. The likelihood of choosing microbial safety-labeled fresh produce or both microbial- and chemical safety-labeled fresh produce increased with nudging among those who have some knowledge of microbial contamination and foodborne illnesses – we found that the interaction of nudging and level of knowledge is significantly positive. Youth belonging to higher income classes do not necessarily have a higher affinity to safer fresh produce but with nudging, the higher income class youth have a higher likelihood of choosing safer fresh produce choices.Research limitations/implicationsYouth engagement and their awareness of food safety could be one of the important strategies to potentially develop them as effective promoters, adopters and educators in enhancing food safety in food systems in Nepal. Our predicted premium for food safety attributes points to the potential scope for the emerging market segment or business opportunities augmenting food safety in Nepal.Originality/valueWe examined the factors influencing the safer fresh produce choices among youth in Nepal. We tested whether awareness levels of microbial contamination and foodborne illness and information nudging affect the likelihood of safer fresh produce choice. Then we predicted the willingness to pay (premium) for safety attributes. To the best of our knowledge, none of the previous studies have examined this aspect in Nepal.

AI-based opportunistic quantitative image analysis of lung cancer screening CTs to reduce disparities in osteoporosis screening

Osteoporosis is underdiagnosed, especially in ethnic and racial minorities who are thought to be protected against bone loss, but often have worse outcomes after an osteoporotic fracture. We aimed to determine the prevalence of osteoporosis by opportunistic CT in patients who underwent lung cancer screening (LCS) using non-contrast CT in the Northeastern United States. Demographics including race and ethnicity were retrieved. We assessed trabecular bone and body composition using a fully-automated artificial intelligence algorithm. ROIs were placed at T12 vertebral body for attenuation measurements in Hounsfield Units (HU). Two validated thresholds were used to diagnose osteoporosis: high-sensitivity threshold (115–165 HU) and high specificity threshold (<115 HU). We performed descriptive statistics and ANOVA to compare differences across sex, race, ethnicity, and income class according to neighborhoods' mean household incomes. Forward stepwise regression modeling was used to determine body composition predictors of trabecular attenuation. We included 3708 patients (mean age 64 ± 7 years, 54 % males) who underwent LCS, had available demographic information and an evaluable CT for trabecular attenuation analysis. Using the high sensitivity threshold, osteoporosis was more prevalent in females (74 % vs. 65 % in males, p < 0.0001) and Whites (72 % vs 49 % non-Whites, p < 0.0001). However, osteoporosis was present across all races (38 % Black, 55 % Asian, 56 % Hispanic) and affected all income classes (69 %, 69 %, and 91 % in low, medium, and high-income class, respectively). High visceral/subcutaneous fat-ratio, aortic calcification, and hepatic steatosis were associated with low trabecular attenuation (p < 0.01), whereas muscle mass was positively associated with trabecular attenuation (p < 0.01). In conclusion, osteoporosis is prevalent across all races, income classes and both sexes in patients undergoing LCS. Opportunistic CT using a fully-automated algorithm and uniform imaging protocol is able to detect osteoporosis and body composition without additional testing or radiation. Early identification of patients traditionally thought to be at low risk for bone loss will allow for initiating appropriate treatment to prevent future fragility fractures. ClinicalTrials.gov identifierN/A

Timing and predictors of death during treatment in patients with multidrug/rifampin-resistant tuberculosis in South Korea.

This study aimed to investigate the timing and predictors of death during treatment among patients with multidrug/rifampin-resistant tuberculosis (MDR/RR-TB) in South Korea. This was a retrospective cohort study that included MDR/RR-TB cases notified between 2011 and 2017 in South Korea. Among 7,226 MDR/RR-TB cases, 699 (9.7%) died at a median of 167 days (IQR 51-358 d) from the initiation of MDR-TB treatment. The cumulative proportion of all-cause death was 35.5% at 90 days and 52.8% at 180 days from treatment initiation. TB-related deaths occurred at a median of 133 days (IQR 32-366 d), which was significantly earlier than the median of 184 days (IQR 68-356 d) for non-TB-related deaths (p = 0.002). In a multivariate analysis, older age was the factor most strongly associated with death, with those aged ≥ 75 years being 68 times more likely to die (aHR 68.11, 95% CI 21.75-213.26), compared those aged ≤ 24 years. In addition, male sex, comorbidities (cancer, human immunodeficiency virus, and end stage renal disease), the lowest household income class, and TB-specific factors (previous history of TB treatment, smear positivity, and fluoroquinolone resistance) were identified as independent predictors of all-cause death. This nationwide study highlights increased deaths during the intensive phase and identifies high-risk groups including older people and those with comorbidities or socioeconomic vulnerabilities. An integrated and comprehensive strategy is required to reduce mortality in patients with MDR/RR-TB, particularly focusing on the early stages of treatment and target populations.

Footprint analysis and the incidence of emission taxes

We show that the incidence of emission taxes on consumer income classes is proportional to the footprints of their respective consumption bundles. The dimensions of the footprints are industry by product, but the literature employs industry-by-industry input-output coefficients. We rectify footprint analysis by returning to the underlying national accounts, the use and make tables. Bringing in budget shares data of the different income classes (Engel curves), we show that the carbon dioxide footprint per euro expenditure decreases with income in the Netherlands. Our result renders an emission tax regressive and thus implies a tradeoff between environmental and income policies.